Duration of solid fuel cookstove use is associated with increased risk of acute lower respiratory infection among children under six months in rural central India

Assessing the health consequences of indoor air pollution from biomass fuel combustion on pediatric populations in rural communities of Pakistan

Indoor air pollution arising from burning of biomass fuels poses a significant threat to child health in rural areas of Pakistan. This cross-sectional study aimed to assess health implications associated with indoor air pollution resulting from biomass burning among children under 12 years of age in rural Punjab. A questionnaire-based survey was conducted in six randomly selected rural districts of Punjab, characterized by their primary reliance on biomass fuels. The findings revealed that several characteristics, such as monthly household income, number of living rooms, secondary use of solid fuels, kitchen type, type of cooking stove, and presence of child in the kitchen with their mother, exhibited significant associations (p < 0.05) with negative health impacts among children. Reported health effects among the children included coughing (18.7%), watery eyes (17.7%), eye irritation (12.3%), runny nose (11.8%), breathing difficulties (8.5%), phlegm (38%), headache (25%), nausea (20.1%), dizziness (6.7%), asthma (6.4%), tuberculosis (1.8%), and pneumonia (1.5%).

Health effects associated with exposure to secondhand smoke: a Burden of Proof study

Despite a gradual decline in smoking rates over time, exposure to secondhand smoke (SHS) continues to cause harm to nonsmokers, who are disproportionately children and women living in low- and middle-income countries. We comprehensively reviewed the literature published by July 2022 concerning the adverse impacts of SHS exposure on nine health outcomes. Following, we quantified each exposure-response association accounting for various sources of uncertainty and evaluated the strength of the evidence supporting our analyses using the Burden of Proof Risk Function methodology. We found all nine health outcomes to be associated with SHS exposure. We conservatively estimated that SHS increases the risk of ischemic heart disease, stroke, type 2 diabetes and lung cancer by at least around 8%, 5%, 1% and 1%, respectively, with the evidence supporting these harmful associations rated as weak (two stars). The evidence supporting the harmful associations between SHS and otitis media, asthma, lower respiratory infections, breast cancer and chronic obstructive pulmonary disease was weaker (one star). Despite the weak underlying evidence for these associations, our results reinforce the harmful effects of SHS on health and the need to prioritize advancing efforts to reduce active and passive smoking through a combination of public health policies and education initiatives.

Exploring the links between indoor air pollutants and health outcomes in South Asian countries: a systematic review

Indoor air pollution (IAP) has adverse effects on the health of people, globally. The objective of this systematic review was to present the range of health problems studied in association with indoor air pollutants in South Asian countries. We searched five databases, including PubMed, Web of Science, Scopus, Google Scholar, and CAB Direct for articles published between the years 2000 and 2020. We retrieved 5,810 articles, out of which we included 90 articles in our review. Among South Asian countries, only five countries have published results related to relationship between indoor air pollutants and adverse health conditions. All studies have shown adversity of indoor air pollutants on human's health. We found indoor solid fuel burning as a key source of indoor air pollution in the included studies, while women and children were most affected by their exposure to solid fuel burning. More than half of the studies accounted particulate matter responsible for indoor air pollution bearing negative health effects. In the included studies, eyes and lungs were the most commonly affected body organs, exhibiting common symptoms like cough, breathing difficulty and wheezing. This might have developed into common conditions like respiratory tract infection, chronic obstructive pulmonary diseases and eye cataract. In addition to promote research in South Asian countries, future research should focus on novel digital ways of capturing effects of indoor air pollutants among vulnerable segments of the population. As a result of this new knowledge, public health agencies should develop and test interventions to reduce people's exposure levels and prevent them to develop adverse health outcomes.

Spatial epidemiology of acute respiratory infections in children under 5 years and associated risk factors in India: District-level analysis of health, household, and environmental datasets

Background

In India, acute respiratory infections (ARIs) are a leading cause of mortality in children under 5 years. Mapping the hotspots of ARIs and the associated risk factors can help understand their association at the district level across India.

Methods

Data on ARIs in children under 5 years and household variables (unclean fuel, improved sanitation, mean maternal BMI, mean household size, mean number of children, median months of breastfeeding the children, percentage of poor households, diarrhea in children, low birth weight, tobacco use, and immunization status of children) were obtained from the National Family Health Survey-4. Surface and ground-monitored PM_2.5 and PM₁₀ datasets were collected from the Global Estimates and National Ambient Air Quality Monitoring Programme. Population density and illiteracy data were extracted from the Census of India. The geographic information system was used for mapping, and ARI hotspots were identified using the Getis-Ord Gi^* spatial statistic. The quasi-Poisson regression model was used to estimate the association between ARI and household, children, maternal, environmental, and demographic factors.

Results

Acute respiratory infections hotspots were predominantly seen in the north Indian states/UTs of Uttar Pradesh, Bihar, Delhi, Haryana, Punjab, and Chandigarh, and also in the border districts of Uttarakhand, Himachal Pradesh, and Jammu and Kashmir. There is a substantial overlap among PM_2.5, PM₁₀, population density, tobacco smoking, and unclean fuel use with hotspots of ARI. The quasi-Poisson regression analysis showed that PM_2.5, illiteracy levels, diarrhea in children, and maternal body mass index were associated with ARI.

Conclusion

To decrease ARI in children, urgent interventions are required to reduce the levels of PM_2.5 and PM₁₀ (major environmental pollutants) in the hotspot districts. Furthermore, improving sanitation, literacy levels, using clean cooking fuel, and curbing indoor smoking may minimize the risk of ARI in children.

Reducing household air pollution exposure to improve early child growth and development; a randomized control trial protocol for the "Poriborton-Extension: The CHANge trial"

Background

Globally, household air pollution (HAP) is a leading environmental cause of morbidity and mortality. Our trial aims to assess the impact of liquefied petroleum gas (LPG) for cooking to reduce household air pollution exposure on child health outcomes, compared to usual cooking practices in Bangladesh. The primary aim is to evaluate if reduced exposure to HAP through the provision of LPG for cooking from early gestation through to age 2 improves child anthropometry, health, and neuro-cognitive developmental outcomes, compared to children exposed to emissions from usual practice.

Methods

Two-arm parallel cluster randomized controlled trial (cCRT). We will extend the intervention and follow-up of our existing “Poriborton” trial. In a subset of the original surviving participants, we will supply LPG cylinders and LPG stoves (intervention) compared to usual cooking practices and extend the follow-up to 24 months of age. The expected final sample size, for both (intervention and control) is 1854 children with follow-up to 2 years of age available for analysis.

Discussion

This trial will answer important research gaps related to HAP and child health and neuro-cognitive developmental outcomes. This evidence will help to understand the impact of a HAP intervention on child health to inform policies for the adoption of clean fuel in Bangladesh and other similar settings.

Trial registration

The Poriborton: Change trial: Household Air Pollution and Perinatal and early Neonatal mortality is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001214224, original trial registered on 19th July 2018, extension approved on 23rd June 2021. www.anzctr.org.au.

Indoor air pollution from solid fuel on children pneumonia in low- and middle-income countries: a systematic review and meta-analysis

An updated systematic review was conducted to assessing on the association between indoor air pollution caused by household energy consumption and childhood pneumonia in low- and middle-income countries. We performed a meta-analysis from the electronic databases of PubMed, Cochrane library, Web of Science, EMBASE. Studies were selected when they reported childhood pneumonia or ALRI in relation to indoor air pollution resulted from solid fuel. Studies must provide results on exposure prevalence of children aged below 5 years from Asia or Africa. We devoted ourselves to identifying randomized controlled experiments and observational epidemiological researches, which revealed the relation between household usage of solid fuel and childhood pneumonia. Among 1954 articles, 276 were reviewed thoroughly and 16 conduced to such a meta-analysis. It was found that there is a significant relationship between the solid fuel combustion and increasing risk of childhood pneumonia (OR = 1.66, 95%CI 1.36-2.02). The summary odds ratios from biomass use and mixed fuel use were, respectively, 1.86 (95%CI 1.15-3.02) and 1.58 (95%CI 1.38-1.81), with substantial between study heterogeneity (I² = 87.2% and 29.2%, respectively). According to the subgroup analysis along with the meta-regression analysis, the risk of using solid fuel in Asian regions is higher than that in African regions. Studies based on non-hospital participates (I² = 49.5%) may also a source of heterogeneity. We found that indoor air pollution generated by the usage of solid fuel might be a significant risk factor for pneumonia in children and suggested improving the indoor air quality by promoting cleaner fuel will be important in undeveloped countries.

Association between household solid fuel use for cooking and sleep disturbance in rural China: findings from the China Kadoorie Biobank data

BACKGROUND

Solid fuel use for cooking is a main source of household air pollution, particularly in rural China. Evidence on the association between household air pollution and sleep quality remains limited. This study aimed to examine the association between household solid fuels used for cooking and sleep disturbance.

METHODS

The data of 283,170 adults from baseline survey of the China Kadoorie Biobank Study were included. Detailed information about exposure to solid fuels used for cooking were collected. Sleep disturbance was indicated as any of the three sleep disorders, including disorders of initiating and maintaining sleep, disorders of early morning awakening, and daytime dysfunction. Logistic regression analysis was used to examine the association between sleep disturbance and level of exposure to household solid fuels used for cooking.

RESULTS

About 18% of participants reported sleep disturbance. Fully adjusted analysis indicated exposure to household solid fuels used for cooking was significantly associated with sleep disturbance. Compared to those with 0-3 years exposure (first tertile) to solid fuels used for cooking, the participants with 3-26 years exposure (second tertile) and >26 years exposure (third tertile) had greater odds of having sleep disturbance at 1.16 (95% CI: 1.12-1.19) and 1.33 (95% CI: 1.29-1.37) times, respectively.

CONCLUSIONS

Use of household solid fuels is associated with prevalence of sleep disturbance; the longer duration of exposure to solid fuels use for cooking, the higher is the prevalence of sleep disturbance. Further study is warranted to examine the underlying mechanisms of the association.

Household air pollution related to biomass cook stove emissions and its interaction with improved cookstoves

Introduction

Household air pollution (HAP) is associated with significant global morbidity and mortality. Newer initiatives including improved cookstove (IC) and cleaner fuels are being implemented to improve HAP effects.

Methods

A literature review was conducted for household air pollution related to biomass cookstoves in resource limited countries. In January 2018, we electronically searched the PubMed database for the term cookstoves with no date restrictions. We included cohort, case-control, cross-sectional studies, conference abstracts, editorials, and reviews; studies that assessed the emissions related to cookstove and factors affecting HAP emissions.

Results

Twenty-three articles met the objectives of the review. Fine particulate matter with aerodynamic diameter <2.5 µm (PM_2.5), carbon monoxide (CO) and polycyclic aromatic hydrocarbons (PAH) are the major HAP emissions. Emission factors are based on the stove and fuel used while the activity is based on cooking practices. Changes in composition and sources of PM_2.5 causes modification to its resulting toxicity. Many PAHs and their metabolites released by HAP have carcinogenic, teratogenic and mutagenic potential. Improving ventilation decreases concentrations of PM_2.5 and CO in the household air. Few standard tools are available to measure ventilation and continued IC efficacy in long term.

Conclusion

Unavailability of tools to measure ventilation and continued IC efficacy in long term affect uniformity and comparability of IC study results. Community education about the health effects of HAP and importance of ventilation in decreasing HAP is an important aspect of public health policy to prevent HAP effects.

Health effects of household air pollution related to biomass cook stoves in resource limited countries and its mitigation by improved cookstoves

BACKGROUND

Household air pollution (HAP) related to cooking is associated with significant global morbidity and mortality. An estimated three billion people worldwide are exposed to cooking related HAP caused by solid fuel combustion. This exposure is highest for the vulnerable population of women and children resulting in significant cumulative health effects.

METHODS

A literature review was conducted for health effects of household air pollution related to biomass cookstoves in resource limited countries and to evaluate the effect of improved cookstoves on these health effects. We searched PubMed, Embase and Cochrane Library. We conducted searches in January 2018 with a repeat in February 2020. We included only studies conducted in resource limited countries, published in English, irrespective of publication year and studies that examined the health effects of HAP and/or studied the effects of improved cookstove (IC). Two authors independently screened journal article titles, abstracts and full-text articles to identify those that included the following search term: biomass cookstoves and health risks. We also assessed the limitations of IC with barriers to their uptake.

RESULTS

Health effects associated with HAP mostly include increased blood pressure (BP), dyspnea, childhood pneumonia, lung cancer, low birthweight and cardiovascular diseases. Being a global problem with divergent environmental factors including wide variety of fuel used, housing condition, foods prepared, climatic condition and social factors; most solutions though efficient seems inadequate. Improved cookstove (IC) mitigates emissions and improves short term health, though few randomized long-term studies could substantiate its long-standing continuance and health benefits.

CONCLUSION

There is ample data about the health effects of HAP, with some benefit with IC intervention for elevated blood pressure, dyspnea symptoms, mutagenicity and cardiovascular diseases. IC does not have any benefit in pregnancy outcomes or children health.